'Here to stay': changes to prescribing medication in general practice during the COVID-19 pandemic in New Zealand.

INTRODUCTION The delivery of health care by primary care general practices rapidly changed in response to the coronavirus disease 2019 (COVID-19) pandemic in early 2020. AIM This study explores the experience of a large group of New Zealand general practice health-care professionals with changes to prescribing medication during the COVID-19 pandemic. METHODS We qualitatively analysed a subtheme on prescribing medication from the General Practice Pandemic Experience New Zealand (GPPENZ) study, where general practice team members nationwide were invited to participate in five surveys over 16 weeks from 8 May 2020. RESULTS Overall, 78 (48%) of 164 participants enrolled in the study completed all surveys. Five themes were identified: changes to prescribing medicines; benefits of electronic prescription; technical challenges; clinical and medication supply challenges; and opportunities for the future. There was a rapid adoption of electronic prescribing as an adjunct to use of telehealth, minimising in-person consultations and paper prescription handling. Many found electronic prescribing an efficient and streamlined processes, whereas others had technical barriers and transmission to pharmacies was unreliable with sometimes incompatible systems. There was initially increased demand for repeat medications, and at the same time, concern that vulnerable patients did not have usual access to medication. The benefits of innovation at a time of crisis were recognised and respondents were optimistic that e-prescribing technical challenges could be resolved. DISCUSSION Improving e-prescribing technology between prescribers and dispensers, initiatives to maintain access to medication, particularly for vulnerable populations, and permanent regulatory changes will help patients continue to access their medications through future pandemic disruption.

Lipid monitoring in a community cohort of people taking statins: who is tested and is testing associated with subsequent alteration in therapy?

AIM: To describe patterns of community lipid testing and subsequent therapeutic alteration in a cohort of patients taking statins. METHOD: We conducted a population-based cohort study. Our cohort comprised all people enrolled with a general practice in the Pegasus Health primary care network in Canterbury, New Zealand between 1 January 2016 and 31 December 2017 who were dispensed a statin between 1 January 2016 and 30 June 2016. We defined two six-month study periods: a baseline period (1 January to 30 June 2016) and a follow-up period (1 July to 31 December 2017). We identified statin dispensings for all people in our cohort in both study periods, and identified instances of lipid testing in the 12 months following each person's most recent baseline period dispensing. We examined the effect of gender, ethnicity and socioeconomic deprivation on the likelihood of lipid testing; and compared frequency of alteration of statin dose or type among tested and non-tested people. RESULTS: Data were available for analysis for 32,943 individuals who were dispensed a statin in the baseline period. Lipid testing was performed in 16,199 (49.2%) of individuals. Women were less likely to have been tested than men (OR 0.87, 95% CI 0.83-0.91). Compared to those with European ethnicity, testing was more likely for Maori (OR 1.20, 95% CI 1.07-1.34), Pacific (OR 1.22, 95% CI 1.03-1.44) and Asian (OR 1.41, 95% CI 1.25-1.59) individuals. Socioeconomic deprivation was associated with reduced testing (OR 0.80, 95% CI 0.74-0.87). Dose or type of statin dispensed was altered between baseline and follow-up study periods in 3,762 (23.2%) of those who were tested, and in 3,122 (18.6%) of those who were not tested (OR 1.32, 95% CI 1.25-1.39). CONCLUSION: Almost half (49.1%) of patients had a lipid test within 12 months of baseline period statin dispensing. Lipid testing was more likely for Maori, Pacific and Asian patients than for European patients. Testing was less likely for women and for those with greater socioeconomic deprivation. Subsequent statin therapy alteration was slightly more likely for those who had been tested than for those who had not.